The women's problem we need to talk about

Although women can be open about many things, admitting that you wet yourself is not something easily shared. As Laura says, 'My sister is a nurse and has a much more down-to-earth attitude to bodily functions. When we each had terrible coughs and I was wetting myself, hearing her say she'd had to send her husband out to buy her some pads made me feel much better.'

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'Then a few days later another friend made a passing remark about how you know your pelvic floor is weak when you get a bad cough in your forties.'

It's easy to underestimate how many women experience episodes of incontinence. Sometimes it's only now and then, such as when coughing or sneezing, but for other women it can be a daily occurrence, triggered by laughing, carrying something heavy, climbing stairs or exercising.

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Known as stress incontinence, because the opening from the bladder to the urethra doesn't stay closed under physical stress or pressure, the condition is experienced by up to 1 in 3 women. As women don't always admit to it, many more may actually be affected by stress incontinence.

Many women prefer to suffer in silence instead. There is still a taboo around admitting to bladder weakness. Alex, who is in her early fifties and going through the menopause, has started to notice a change to her bladder when she coughs. 'I've managed with a few sheets of loo paper when it happens, but perhaps that's because I don't want any pads in my bathroom.'

Claire gave up exercise classes when she noticed the problem, but continued running, alone. 'I realised that what I had was pretty bad – it was more than a few drops. I wasn't embarrassed to talk about it with women who'd had children, but I don't think women are prepared for the changes that childbirth can make to your body. It really affected my confidence.'

How to help yourself

Admitting there is a problem is the first step to solving it. Consultant gynaecologist Julian Brady says, 'The take home message for women of all ages is that stress incontinence is very common. Don't be embarrassed – seek help and advice.'

Elaine Miller is someone who is trying to take the embarrassment out of stress incontinence. She is a pelvic physiotherapist but also a comedian. Performing throughout the UK and internationally, her show named 'Gusset Grippers', takes the taboo out of the subject and she offers expert advice during her performances. She offers reminders to do your exercises as @GussieGrips on Twitter.

The correct way to perform pelvic floor exercises

Elaine Miller says: 'Bladder weakness is not an inevitable consequence of ageing or giving birth. Doing your pelvic floor exercises correctly has a 70-80 per cent success rate. But it's doing them correctly that is important as well as continuing for several months.

'Women can become disheartened quickly because progress is quite slow. Also, up to a third of women perform the exercises incorrectly – so they don't work.'

So what is the correct way? Miller says: 'You're lifting and squeezing all three openings together and you feel is as if you are stopping yourself passing wind. If you can't feel anything, try the exercise lying down on your tummy with a pillow under your hips. If this fails and you still can't feel anything, find a hand mirror and take a look: you ought to see a small contraction as you lift and squeeze.

'Count to 10 with each squeeze, then relax. Do this 10 times in a row, then do 10 quick squeezes without holding. You need to do this three times a day, for at least 16 weeks to see progress. If you aren't sure if you are doing them correctly, see a women's physiotherapist.'

It's easy to forget to do exercises during a busy day. There is an NHS app which can remind you. Your GP can refer you to a women's physiotherapist, or you can often self-refer.

Miller suggests setting your phone alarm to remind you or doing the exercises when you clean your teeth or make a drink.

Along with exercises, other lifestyle measures are helpful. Miller suggests: 'Caffeine, alcohol, bubbles and citrus drinks are bladder irritants. Drink plenty of water or decaff drinks instead. Being constipated irritates the bladder, so sort that out too.'

Further help

If pelvic floor exercises don't help enough, there are other treatments available. These include surgery where a supportive tape can be used to lift the urethra into the correct position. Miller says, 'There isn't a measure of whether you need surgery – it's about the 'bother index'. Some women with a small prolapse find it interferes with their lives whereas others women with larger ones manage well.

If you have done as much as you can with lifestyle changes, which could include losing weight and avoiding impact exercise, then you may want to discuss surgery. But even surgery doesn't mean you can give up on pelvic floor exercises afterwards.' Claire decided to have surgery after working at strengthening her pelvic floor for around eighteen months.

If you are over 45 and approaching the menopause, or are post menopausal, falling oestrogen levels can cause incontinence because the lining of the vagina, bladder and urethra are dependent on oestrogen for their health and 'plumpness'. Atrophy occurs post menopause and this can cause many symptoms including stress incontinence and needing the loo more often. HRT as a vaginal cream often helps although it won't cure significant damage after childbirth.

If you are experiencing incontinence, and want further support or advice, always talk to your GP.

Many women can feel alone or embarrassed, but stats show at least one in three women experience bladder weakness. So you can be sure that some of your friends, neighbours and even the woman at the supermarket checkout will be going through the same. Talking about it more openly will enable all women to know there is support and help out there.

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